牛肺磷表面活性物质辅助呼吸机治疗新生儿呼吸窘迫综合征的疗效分析

The curative effect of bovine pulmonary surfactant assisted ventilator in the treatment of neonatal respiratory distress syndrome

目的探讨牛肺磷表面活性物质辅助呼吸机治疗新生儿呼吸窘迫综合征(NRDS)的临床价值。方法采集2014年1月至2018年7月我院收治的NRDS 106例,按治疗方式分为A组(牛肺磷表面活性物质+机械通气,n=62)与B组(猪肺磷脂注射液+机械通气,n=44),比较两组治疗前后X射线胸片改变、血气指标动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、酸碱值(pH)、呼吸机参数(吸氧浓度、呼气末正压、气道峰压、通气频率)的变化及上机情况,统计两组并发症发生率。结果治疗后,两组胸部X射线分级均优化,但组间比较差异无统计学意义(P>0.05);治疗1 h、24 h两组PaO2、pH均上升,PaCO2、吸氧浓度、呼气末正压、气道峰压、通气频率降低,组内不同时间点比较差异有统计学意义(P<0.05),组间各时间点比较差异均无统计学意义(P>0.05);两组机械通气时间、上机前吸氧时间、撤机后吸氧时间及住院时间比较差异无统计学意义(P>0.05),A组住院费用低于B组(P<0.05);两组并发症发生率比较差异无统计学意义(P>0.05)。结论牛肺磷表面活性物质辅助呼吸机治疗NRDS效果与猪肺磷脂注射液联合呼吸机辅助机械通气相似,均可提升NRDS肺部顺应性,改善氧合及肺部通气、换气功能,且价格更低廉,更易于接受与推广。

Objective To explore the clinical value of bovine phosphonium surfactant(PS)assisted ventilator in the treatment of neonatal respiratory distress syndrome(NRDS).Methods From January 2014 to July 2018,106 children with NRDS were admitted to our hospital.According to the treatment method,they were divided into group A(bovine phosphonium surfactant and mechanical ventilation,n=62)and group B(Poractant Alfa Injection and mechanical ventilation,n=44).Changes in X-ray chest film,blood gas indexes including arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2)and pH,changes of ventilator parameters such as concentration of oxygen inhalation,positive end-expiratory pressure,airway peak pressure and ventilation rate,and use of ventilator before and after treatment were compared between the two groups.The incidence rates of complications in both groups were statistically analyzed.Results After treatment,chest X-ray grades in both groups were optimized,but there was no significant differences between groups(P>0.05).After 1 h and 24 h of treatment,PaO2 and PH in both groups were increased while PaCO2,concentration of oxygen inhalation,positive end-expiratory pressure,airway peak pressure,and ventilation rate were decreased.There were significant differences in the above indexes within the same group at different time points(P<0.05).However,there was no significant difference between the two groups at each time point(P>0.05).There was no significant difference in the duration of mechanical ventilation,time of oxygen inhalation before putting on the life-support machine,oxygen inhalation time after weaning or hospital stay between the two groups(P>0.05).There was no significant difference in the incidence rate of complications between the two groups(P>0.05).Conclusion The effect of bovine PS assisted ventilator is similar to that of Poractant Alfa Injection combined with mechanical ventilation in the treatment of NRDS.Both methods can improve the pulmonary compliance in NRDS,improve the oxygenation,pulmonary ventilation and ventilation function.The former is cheaper and is easier to be accepted and promoted.